BODY MRI PROTOCOLS. Updated 03/02/2018

Transcription

1 BODY MRI PROTOCOLS Abdomen Updated 03/02/2018 Pelvis Limited Abdomen and Pelvis MRCP Anal Fistula Prostate Cancer Staging Basic (limited) Abdomen Pancreas Routine Female Pelvis Dynamic (multiparametric) Prostate Basic (limited) Pelvis Adrenal Female Pelvis Mullerian Appendicitis Pregnant Dynamic Liver Renal Mass Cervical CA Staging Defecography Eovist Liver Urogram Endometrial Cancer Rectal Cancer Liver for Hemotomocrosis Enterography Urethral MRA/MRV Other Renal MRA Aorta (CAP) MRA MRV Pelvis DVT Fetal Mesenteric MRA Chest - general 1

2 Limited Abdomen and Pelvis (Cancer surveillance, non-specific clinical history) Axial In/Out Pelvis Axial T2 FS Pelvis Axial 3D VIBE FS Pre Pelvis Axial In/Out Abdomen Axial T2 Abdomen Coronal T2 Abdomen/Pelvis Axial 3D VIBE FS Pre Abdomen Axial 3D VIBE FS Post Abdomen (arterial) Axial 3D VIBE FS Post Abdomen (venous) Axial 3D VIBE FS Post Pelvis Coronal 3D VIBE FS Abdomen/Pelvis AX IN/OUT PHASE PEL and 2.4 FOV MATRIX SLICE GAP FREQ PHASE PHASE FREQ PHASE DIR SCAN DIR A/P 1 S->I AX T2 FS PELVIS A/P 1 S->I AX VIBE PELVIS A/P 1 S->I AX IN/OUT PHASE ABD and A/P 1 S->I AX T2 ABD A/P 1 S->I COR T2 ABD/PELVIS R/L 1 P->A AX VIBE FS PRE ABD A/P 1 S->I AX VIBE FS POST A/P 1 S->I ABD(ARTERIAL/VENOUS) AX VIBE FS POST PELVIS A/P 1 S->I COR VIBE FS POST ABD/PEL R/L 1 P->A 2

3 Basic Abdomen (Abscess, non-specific clinical history, non-organ evaluation) Coronal T2 Axial T2 RESP TRIGGERED or T2 Breath held Axial T2 FS Axial In/Out Axial 3D VIBE FS Pre Coronal 3D VIBE FS Pre Axial 3D VIBE FS Post Arterial Coronal 3D VIBE FS Post Delayed FOV MATRIX PHASE SCAN SLICE GAP FREQ PHASE PHASE FREQ DIR DIR COR T R/L 1 P->A AX T2 RESP TRIG/BH A/P S->I AX T2 FS A/P 1 S->I 1.2 AX IN/OUT PHASE 170 and A/P 1 S->I 2.4 AX VIBE FS PRE A/P 1 S->I COR VIBE FS PRE R/L 1 P->A AX VIBE FS POST (arterial) A/P 1 S->I COR VIBE FS POST R/L 1 P->A 3

4 Basic Pelvis (Abscess, non-specific clinical history) Axial T2 FS Axial In/Out Axial 3D VIBE FS Pre Axial 3D VIBE FS Post Coronal 3D VIBE FS Post FOV MATRIX PHASE SCAN SLICE GAP FREQ PHASE PHASE FREQ DIR DIR AX T2 FS A/P 1 S->I 1.2 AX IN/OUT PHASE 170 and A/P 1 S->I 2.4 AX VIBE FS PRE A/P 1 S->I COR VIBE FS PRE R/L 1 P->A AX VIBE FS POST A/P 1 S->I COR VIBE FS POST R/L 1 P->A 4

5 Dynamic Liver (HCC, Cholangiocarcinoma, lesion characterization) COR T2 AXIAL T2 BH AXIAL T2 FS BH AXIAL IN/OUT PHASE AXIAL 3D VIBE FS PRE AXIAL 3D VIBE FS POST (30 SEC/1 MIN/3 MIN) *with subtractions CORONAL 3D VIBE FS POST (5 MIN) AXIAL DIFFUSION (b value 50 and 750) Need ADC maps FOV Matrix COR T R/L 1 P->A AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I 1.2/2.4 (3T) AXIAL IN/OUT /4.4(1.5T) PHASE A/P 1 S->I AXIAL VIBE FS PRE AXIAL VIBE FS POST COR VIBE FS POST AXIAL DIFFUSION A/P 1 S->I A/P 1 S->I R/L 1 P->A A/P NA S->I B VALUE: 50/400/750 5

6 Eovist Liver (R/O mets, if FNH/adenoma suspected, biliary leaks) CORONAL T2 AXIAL T2 AXIAL T2 FS AXIAL IN/OUT PHASE AXIAL 3D VIBE FS AXIAL 3D VIBE FS POST (2 phase arterial/1 MIN/3 MIN) CORONAL 3D VIBE FS POST (4 MIN) AXIAL 3D VIBE FS POST (5 MIN) AXIAL 3D VIBE FS POST (20 MIN) CORONAL 3D VIBE FS POST (20 MIN) *with subtractions COR T R/L 1 P->A AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I 1.2/2.4 (3T) AXIAL IN/OUT 170 PHASE 2.2/4.4(1.5T) A/P 1 S->I AXIAL VIBE FS PRE AXIAL VIBE FS POST COR VIBE FS POST A/P 1 S->I A/P 1 S->I R/L 1 P->A 6

7 Liver for Hemochromatosis **Must be done on 1.5T ner** Axial GRE 90 degree flip TE 4.0 Axial GRE 20 degree flip TE 4.0 Axial GRE 20 degree flip TE 9.0 Axial GRE 20 degree flip TE 14.0 Axial GRE 20 degree flip TE 21.0 FOV MATRIX PHASE SCAN SLICE GAP FREQ PHASE PHASE FREQ DIR DIR Axial GRE 90 degree flip TE A/P 1 S->I Flip Angle: 90 Axial GRE 20 degree flip TE A/P 1 S->I Flip Angle: 20 Axial GRE 20 degree flip TE A/P 1 S->I Flip Angle: 20 Axial GRE 20 degree flip TE A/P 1 S->I Flip Angle: 20 Axial GRE 20 degree flip TE A/P 1 S->I Flip Angle: 20 7

8 MRCP (Patient prep: NPO 4 hours prior. Arrive min early for ml of PO pineapple juice) COR T2 AXIAL T2 AXIAL IN/OUT PHASE THICK SLAB SSFSE 4 OBLIQ PLANES THROUGH PANC/CBD/GB 40MM THICK COR 3D VOLUME RESPIRATORY TRIGGERED MRCP* 1. THIN COR MIP IMAGES CREATED FROM THIS 1.6/ THIN AX MIP CREATED FROM THIS 1.6/0.8 *DO BREATH HOLD COR 3D ACQUISITION IF THE RESPIRATORY TRIGGER IS POOR IF SECRETIN EXAM: *SECRETIN: ADULT: 0.2µg/kg IV SLOWLY PUSHED OVER 1 MINUTE PEDIATRIC: 0.2µg/kg (MAX DOSE 16 µg) *ADMINISTERED BY ANGIO RN IV PUSH THICK SLAB SSFSE THROUGH PLANE OF PANCREATIC DUCT EVERY MINUTE FOR 10 MINUTES (STACKED) THICK SLAB ANGLES 8

9 MRCP cont. COR T R/L 1 P->A AXIAL T A/P 1 S->I 1.2/2.4 (3T) AXIAL IN/OUT /4.4(1.5T) A/P 1 S->I PHASE COR THICK SLAB L/R 1 P->A SAG THK SLAB P/A 1 P->A COR OBLIQ SLAB P/A 1 P->A COR OBLIQ SLAB P/A 1 P->A COR 3D RESP TRIGGERED R/L 1.7 P->A COR 3D BREATH HOLD R/L 1.4 P->A COR THK SLAB POST SECRETIN P/A 1 P->A RUN X 10 9

10 Pancreas Patient Prep: NPO for 4 hours If MRCP is NOT requested, give 750mL water (PO) starting 60 minutes prior to exam CORONAL T2 AXIAL T2 AXIAL T2 FS AXIAL IN/OUT PHASE AXIAL 3D VIBE FS PRE AXIAL 3D VIBE FS POST (35 SEC/70 SEC/3 MIN) thickness 3mm CORONAL 3D VIBE FS POST (3 MIN) COR T R/L 1 P->A AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I 1.2/2.4 (3T) AXIAL IN/OUT /4.4(1.5T) PHASE A/P 1 S->I AXIAL VIBE FS PRE AXIAL VIBE FS POST COR VIBE FS POST A/P 1 S->I A/P 1 S->I R/L 1 P->A 10

11 Adrenal If indication is adrenal adenoma, call rad o check after IN/OUT phase series CORONAL T2: diaphragm to aortic bifurcation AXIAL IN/OUT PHASE Adrenals CORONAL IN/OUT PHASE Adrenals AXIAL T2 FS: diaphragm to aortic bifurcation AXIAL 3D VIBE FS PRE: diaphragm to aortic bifurcation AXIAL 3D VIBE FS POST: diaphragm to aortic bifurcation (35 SEC/70 SEC) CORONAL 3D VIBE FS POST (3 MIN) COR T R/L 1 P->A AXIAL IN/OUT PHASE COR IN/OUT PHASE /2.4 (3T) 2.2/4.4(1.5T) A/P 1 S->I 1.2/2.4 (3T) 2.2/4.4(1.5T) A/P 1 S->I AXIAL T2 FS A/P 1 S->I AXIAL VIBE FS PRE A/P 1 S->I AXIAL VIBE FS POST A/P 1 S->I COR VIBE FS POST R/L 1 P->A 11

12 Renal Mass FOV limited to kidneys CORONAL T2 AXIAL T2 AXIAL T2 FS AXIAL IN/OUT PHASE AXIAL 3D VIBE PRE SAGITTAL 3D VIBE FS PRE of each kidney CORONAL 3D VIBE FS PRE CORONAL 3D VIBE FS POST (25 SEC/90 SEC) SAGITTAL 3D VIBE FS POST of each kidney AXIAL 3D VIBE FS POST **If patient cannot receive gadolinium** AXIAL DIFFUSION X2 (b value of 50 and 750) and ADC maps COR T R/L 1 P->A AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I AXIAL IN/OUT 1.2/2.4 (3T) A/P 1 S->I PHASE 2.2/4.4(1.5T) AXIAL VIBE FS PRE A/P 1 S->I SAG VIBE FS (each kidney) A/P 1 L->R COR VIBE FS PRE A/P 1 S->I COR VIBE FS POST A/P 1 S->I SAG VIBE FS POST (each kidney) A/P 1 L->R AX VIBE FS POST R/L 1 P->A AXIAL DIFFUSION A/P NA S->I B VALUE: 50/400/750 12

13 Urogram Patient Prep: Arrive 1 hour prior to get IVF Empty bladder prior to getting on table Adult: 500mL NS bolus immediately before scan Pediatric: weight based IVF: 4mL/kg/hr 1 st 10kg 2mL/kg/hr next 10kg 1mL/kg/hr for each kg above 20kg Adults: arrive 1 hour prior to angio for IV placement, fluids, possible catheter placement(optional) *Lasix dose: 20-40mg slow IV push Pediatrics: Requires Pain Free and catheter (can administer Lasix) *Lasix dose: 1mg/kg (up to max dose 20mg) slow IV push CORONAL T2 Abdomen/Pelvis CORONAL T2 FS Abdomen/Pelvis AXIAL T1 FS Abdomen/Pelvis AXIAL T2 Abdomen/Pelvis AXIAL T2 FS Abdomen/Pelvis **Inject Lasix** CORONAL T2 Thick Slabs CORONAL T2 Thin (1mm) Respiratory Triggered Kidneys/Ureters - Need 3D reconstructions CORONAL 3D VIBE FS PRE CORONAL 3D VIBE FS POST - Coronal oblique plane to include kidneys and bladder (2mm slice thickness) - Arterial (~30 sec), 60 SEC (PVP), 100 SEC (nephrographic), 8 MIN (excretory) - Automatic MIP images of each volume acquired **Have Rad Check** CORONAL 3D VIBE FS POST (need to see ureters to bladder) (10 MIN) SAGITTAL 3D VIBE FS POST: of each kidney (10 MIN) 13

14 Urogram cont. COR T R/L 1 P->A COR T2 FS R/L 1 P->A AXIAL T1 FS A/P 2 S->I AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I COR T2 THK Slabs S/I 1 P->A COR T2 Thin RESP TRIG R/L 1.7 P->A COR VIBE FS PRE A/P 1 S->I COR VIBE FS POST SAG VIBE FS POST A/P 1 S->I R/L 1 P->A 14

15 Enterography Patient prep: Volumen, 3 bottles, 90 minutes prior Glucagon 1 mg IM after THK slabs and CISS Coronal Thick Slabs T2 Coronal T2 CISS **HAVE IMAGES CHECKED BY RADIOLOGIST** *Have RN inject glucagon Coronal T2 BH Axial T2 BH Axial T2 FS BH Axial 3D VIBE FS PRE Coronal 3D VIBE FS PRE Coronal 3D VIBE FS Post (35 seconds and 70 seconds) Axial 3D VIBE FS Post FOV MATRIX SLICE GAP FREQ PHASE PHASE FREQ PHASE DIR Coronal T2 Thick Slabs R->L 1 P->A Coronal T2 CISS R->L 1 P->A Coronal T R/L 1 P->A AX T A/P 1 S->I AX T2 FS A/P 1 S->I AX VIBE FS PRE A/P 1 S->I COR VIBE FS PRE R/L 1 P->A COR VIBE FS POST (35 and 70 sec) R/L 1 P->A AX VIBE FS Post A/P 1 S->I SCAN DIR 15

16 RENAL MRA CORONAL T2 to determine anatomy and location of kidneys AXIAL T2 FS BH AXIAL T2 CISS TRIGGER BH (gated multiphase) CORONAL T2 CISS TRIGGER BH AXIAL 3D VIBE FS PRE CORONAL Angio3D PRE CORONAL Angio3D post (2 phases) - 3D acquisition arterial phase - Reformat into thin AX and COR - 3D reformats of arterial phase) AXIAL 3D VIBE FS POST CORONAL 3D VIBE FS 5 MIN Post 3D PC (IF GAD NOT GIVEN) COR T R/L 1 P->A AX T2 FS A/P 1 S->I AX T2 CISS TRIGGER BH COR T2 CISS TRIGGER BH A/P 1 L->R R/L 1 P->A AX VIBE FS PRE/POST A/P 1 S->I COR Angio3D pre/post COR VIBE FS 5 MIN Post R/L 1 P->A R/L 1 P->A 3D PC R/L 1 S->I 16

17 MESENTERIC MRA CORONAL T2 AXIAL T2 FS BH AXIAL 3D VIBE FS PRE SAGITTAL Angio3D PRE CARE BOLUS SAGITTAL Angio3D post (2 phases) - 3D acquisition arterial phase - Reformat into thin axial and sagittal - 3D reformats of arterial phase AXIAL 3D VIBE FS POST CORONAL 3D VIBE FS 5 MIN Post COR T R/L 1 P->A AX T2 FS A/P 1 S->I AX VIBE PRE/POST COR Angio3D pre/post COR VIBE 5 MIN Post A/P 1 S->I R/L 1 P->A R/L 1 P->A 17

18 AORTA (CAP) MRA If patient cannot get gadolinium must be done on 3T AXIAL DIR (PERIPHERAL GATED) AXIAL T2 CISS (PERIPHERAL GATED) SAGITTAL OBL CINE GRE (PERIPHERAL GATED) AXIAL VIBE PRE Sagittal Oblique Angio3D PRE CARE BOLUS Sagittal Oblique (Candy Cane) Angio3D post - 3D acquisition arterial phase - Reformat into thin axial and sagittal - 3D reformats of arterial phase AXIAL 3D VIBE FS POST Angle for SAG OBL AX DIR A/P 1 S->I AX T2 CISS A/P 1 L->R AX VIBE FS PRE/POST SAG OBL Angio3D pre/post A/P 1 S->I R/L 1 P->A 18

19 Anal Fistula Should be performed on 3T Sagittal T2 (Full FOV, 2.5mm/gap 0mm) *Use to establish oblique planes Axial and coronal to long axis of anal canal MD to check planes if unsure Small FOV (26cm): Axial Oblique T1 (4mm/0.8) Axial Oblique T2 FS (4mm/0.8) Axial Oblique T2 (4mm/0.8) Coronal Oblique T2 FS (4mm/0.8) Coronal Oblique T2 (4mm/0.8) Axial Oblique VIBE FS Pre Axial Oblique VIBE FS Post Coronal Oblique VIBE FS Post SAG T S/I 3 L->R AXIAL OBL T R/L 2 S->I AXIAL OBL T2 FS R/L 2 S->I AXIAL OBL T R/L 2 S->I COR OBL T2 FS 3000 COR OBL T R/L 2 P->A R/L 2 P->A AX VIBE FS PRE A/P 4 S->I AX VIBE FS POST A/P 4 S->I COR VIBE FS POST R/L 4 P->A 19

20 MRV Pelvis DVT 2D TOF reformat into 3D image AXIAL VIBE FS Pre 3D MRV Pre (dry run) 3D MRV Post: in 3 phases (2min/3min/4min) Reformat each phase into axial and sagittal 3D Coronal MIP of each phase AXIAL VIBE FS Post 2D TOF A->P 1 S->I AX VIBE FS Pre R->L 4 S->I 3D MRV Post R->L 1 P->A AX VIBE FS Post R->L 4 S->I 20

21 Routine Female Pelvis Adenomyosis, fibroids, adnexa Planes in relation to the uterus for uterine pathology, otherwise in relation to pelvis Coronal T2 Abdomen/Pelvis Axial T1 whole pelvis Small Axial T1 FS (superior and inferior sat bands) Axial T2 Axial T2 FS Sagittal T2 (uterine evaluation) Sagittal T2 FS *OPTIONAL WITH CONTRAST Axial VIBE FS Pre Axial VIBE FS Post Coronal VIBE FS Post Sagittal VIBE FS Post AXIALS CORONALS FOV Matrix COR T R->L 1 s->i ABD/PEL AX T R->L 1 S->I Whole Pelvis AX T1 FS R->L 2 S->I AX T R->L 2 S->I AX T2 FS R->L 2 S->I SAG T A->P 3 R->L SAG T2 FS A->P 3 R->L AX VIBE FS Pre A->P 4 S->I AX VIBE FS Post A->P 4 S->I COR VIBE FS Post R->L 2 A->P Sag VIBE FS Post A->P 2 R->L 21

22 Female Pelvis Mullerian Planes in relation to the uterus Axial T2 FS Full FOV Axial T1 Full FOV Coronal T2 Full FOV to include kidneys (7mm slice) Small FOV in relation to the uterus: Sagittal T2 (4mm slice) Axial T2 (4mm slice) Coronal T2 (4mm slice) AXIALS CORONALS FOV AX T2 FS A->P 2 S->I Whole AX T R=>L 1 S->I Pelvis COR T R->L 1 A->P Full FOV SAG T A->P 3 R->L AX T R->L 2 S->I COR T R->L 2 A->P 22

23 Cervical Cancer Staging Planes for small FOV axial images in relation to the cervix Axial T1 Abdomen/Pelvis Axial T2 FS Full FOV Pelvis SAG T2 small FOV pelvis Axial Oblique (SAX) T2 small FOV Cervix SAX to the cervix AX T A/P 1 S->I ABD/PEL AX T2 FS A/P 2 S->I Full Pelvis SAG T A/P 3 L->R SAX T R/L 2 S->I 23

24 Endometrial Cancer Planes for small FOV axial/coronal images in relation to the uterus Large Ax T1 upper abdomen and pelvis Ax T2 FS Pelvis full FOV Small Sag T2 Small FOV Axial OBL (SAX of the uterus) T2 Axial OBL (SAX) VIBE PRE Sag VIBE FS PRE Sag VIBE FS POST (1 MIN/3 MIN/5 MIN) Axial OBL (SAX) VIBE FS POST (4 MIN) SAX to the uterus AX T A/P 1 S->I ABD/PEL 64 slabs AX T2 FS A/P 2 S->I Full Pelvis SAG T A/P 3 L->R AX OBL (SAX) T R/L 2 S->I AX OBL (SAX) R/L 1 S->I 72 slabs VIBE FS PRE SAG VIBE FS PRE A/P 1 L->R 61 slabs SAG VIBE FS POST A/P 1 L->R 61 slabs AX OBL (SAX) VIBE FS PRE R/L 1 S->I 72 slabs 24

25 Female Pelvis - Urethral COR T2 (wide FOV to include kidneys) Small FOV (18cm-24cm) centered at urethra: AXIAL T2 FS SAG T2 FS COR T2 FS If indicated (requested by the MD for infection, inflammation, or malignancy): AX VIBE FS PRE AX VIBE FS POST SAG VIBE FSPOST COR VIBE FS POST COR T R/L 1 P->A Full FOV AXIAL T2 FS R/L 3 S->I SAG T2 FS A/P 4 L->R COR T2 FS R/L 4 P->A AXIAL VIBE FS PRE A/P 4 S->I 88 slabs AXIAL VIBE FS POST A/P 4 S->I 88 slabs SAG VIBE FS POST A/P 2 L->R 160 slabs COR VIBE FS POST R/L 2 P->A 176 slabs 25

26 Prostate Cancer Staging For staging or XRT planning Set angles straight to the pelvis and cover prostate and seminal vesicles Axial T1 whole pelvis Small Axial T1 Axial T2 (3mm slice) Sagittal T2 (3mm slice) Coronal T2 (3mm slice) Axial 3D T2 Ax T R->L 1 S->I Ax T R->L 1 S->I Ax T R->L 3 S->I Sag T H->F 3 R->L Cor T R->L 3 P->A Ax 3D T R->L 1.4 S->I 26

27 Dynamic Prostate (Multiparametric) Elevated PSA, negative biopsy Must be done on 3T/phased array body coil Cover entire prostate and seminal vessicles Axial T1 FSE TR/TE 650/10 small FOV(20cm) 3mm/1mm MATRIX 320 Axial T2 small FOV(20cm) 3mm/1mm MATRIX 320 Sagittal T2 small FOV FSE 3mm/1mm Coronal T2 5000/93 Echo train 13 small FOV(20cm) 3mm/1mm MATRIX 320 DWI axial TR/TE 6000/78 flip angle 90, nex 6, b-values 0 and 1000, matrix 128x92 FOV 35cm x35cm 3mm/1mm to cover entire prostate and seminal vesicles. Need ADC maps. Post gadolinium: Axial post gad: rapid dynamic contrast enhanced thickness 4.0/0.0, sequential 16 axial slices, 20 phase acquisition FOV 22 Ax T R->L 1 S->I Ax T R->L 3 S->I Sag T H->F 3 R->L Cor T R->L 3 P->A DWI A->P 6 S->I Dynamic Ax Post a->p 1 S->I b values 0 and

28 APPENDICITIS PREGNANT (R/O APPENDICITIS) CORONAL T2 SSFSE AXIAL T2 SSFSE SAGITTAL T2 SSFSE CORONAL T2 FS BH AXIAL T2 FS BH CORONAL CISS AXIAL CISS (Optional if questioning a kidney stone) COR T2 SSFSE R/L 1 P->A AX T2 SSFSE SAG T2 SSFSE A/P 1 S->I A/P 1 L->R COR T2 FS BH R/L 1 P->A AX T2 FS A/P 1 S->I COR CISS R/L 1 P->A AX CISS A/P 1 S->I 28

29 Defecography Axial T2 Sagittal T2 to obtain midline Sagittal CISS at Rest Sagittal CISS with Kegel Sagittal CISS with minimal straining Sagittal CISS with moderate straining Sagittal CISS with maximum straining Sagittal CISS with defecation AX T2 SAG T Frequenc y Phas e Thicknes s Phas e Frequenc y Directio n Directio n A->P 3 S->I A->P 2 R->L SAG CISS (X6) A->P 1 R->L 1 slice at midline 29

30 Fetal Add T1s for blood, especially in the brain Sagittal T2 Axial T2 Coronal T2 Coronal CISS Sagittal CISS Axial CISS Set angle to the area of interest on the fetus With the smallest FOV possible Sag T2 Ax T2 Cor T Frequenc y Phas e Thicknes s Phas e Frequenc y Directio n Directio n A/P 1 L->R R/L 1 S->I R/L 1 P->A Cor CISS R/L 1 P->A Sag CISS 191 Ax CISS A/P 1 L->R A/P 1 S->I 30

31 Rectal Cancer Should be performed on 3T during the day to be monitored by a radiologist Planes for Small FOV axial/coronal image in relation to rectum Sagittal T2 (Full FOV for planning sequences) Axial T1 (Aortic bifurcation through pelvis) Axial T2 (full FOV) Small Coronal Oblique T2 **Check with radiologist for rectal gel and administer gel if necessary Sagittal T2 (small FOV 3mm slice) Coronal Oblique T2 (small 3mm slice) Axial Oblique T2 (small 3mm slice) Coronal Oblique T2 (small 3mm slice) (angle set to parallel to the long axis of the anal canal to evaluate sphincter involvement) Axial Oblique VIBE FS Pre (small 3mm slice) Axial Oblique VIBE FS Post (small 3mm slice) Coronal Oblique VIBE FS Post (small 3mm slice) Sagittal Oblique VIBE FS Post (small 3mm slice) OBL AXIAL = parallel to long axis rectum OBL CORONAL = perpendicular to long axis rectum MR technologist: if you are uncertain about the oblique axial and coronals, or if the tumor involves the rectum as it curves, call MD to help select the best imaging planes. 31

32 Rectal Cancer Continued SAG T A->P 3 R->L AX T A->P 2 S->I AX T A->P 3 S->I COR OBL T SAG T COR OBL T R->L 4 A->P A=>P 3 R->L R[>L 4 A->P AX OBL T R->L 4 S->I COR OBL T2 (ANUS) R->L 3 S->I AX OBL VIBE FS PRE A->P 4 S->I AX OBL VIBE FS POST A->P 4 S->I COR OBL VIBE FS POST R->L 4 A->P SAG OBL VIBE FS POST A->P 4 R->L 32

33 General Chest (Basic) Use for mediastinal mass/lymphadenopathy/thymus, etc. All sequences should be done with breath hold: COR T2 AXIAL T2 AXIAL T2 FS AXIAL IN/OUT PHASE AX 3D VIBE FS (4mm slices) AX 3D VIBE FS POST (0SEC/30 SEC/60 SEC/120 SEC) Inject and scan at the same time for 0 Sec - Reformat into axial and coronal - Subtractions axial and coronal COR T R/L 1 P->A AXIAL T A/P 1 S->I AXIAL T2 FS A/P 1 S->I 1.2/2.4 (3T) AXIAL IN/OUT 170 PHASE 2.2/4.4(1.5T) A/P 1 S->I AXIAL VIBE FS PRE A/P 1 S->I 64 slabs AXIAL VIBE FS POST A/P 1 S->I 64 slabs 33

34 Image sources: